Journal of cataract and refractive surgery最新文献

Purpose: To investigate the pharmacological accommodative changes of the anterior segment and its impact on the circumferential anterior chamber angle (ACA) after implantable collamer lens (ICL) implantation using swept-source optical coherence tomography (SS-OCT).

Setting: Eye and ENT Hospital, Fudan University, Shanghai, CHINA.

Design: Prospective randomized contralateral eye study.

Methods: Eight men and 24 women (mean age, 28.2 ± 5.8 years; range, 19-42 years); 64 eyes were included at 3 months after ICL implantation. One eye per patient was randomly assigned to undergo tropicamide instillation (mydriasis group), and the contralateral eye underwent pilocarpine instillation (miosis group). SS-OCT examinations were performed before and after instillation to measure angle parameters. Trabecular-iris angle 500 (TIA500), angle opening distance 500 (AOD500), trabecular-iris space area (TISA500), angle opening distance circumference area 500 (AODA500), trabecular-iris circumference volume 500 (TICV500), and central vault (ICL to crystalline lens [ICL-L]) were evaluated.

Results: Relative to baseline levels, TIA500, AOD500, and TISA500 values all increased significantly in both groups (all P < 0.01). AODA500 and TICV500 values increased by 19.7% and 12.1%, respectively, in the mydriasis group (all P < 0.001), and these values similarly increased by 23.4% and 27.7%, respectively, in the miosis group (all P < 0.001). After instillation, the ICL-L decrease in the miosis group was significantly larger than that in the mydriasis group (P = 0.004). Mean AOD500, TISA500, and TICV500 in the miosis group were significantly larger than those in the mydriasis group (all P ≤ 0.036), especially at 8 and 10 o'clock (all P ≤ 0.014). Correlation analyses indicated that the increase in anterior chamber angle parameters was positively correlated with the change in ICL-L for both groups.

Conclusions: Pilocarpine induced a more significant increase in ACA than tropicamide, because of different mechanism of anterior segment changes. We recommend circumferential meridian scan to assess angle status.

Purpose: To improve the accuracy of intraocular lens (IOL) power calculation formulas by modifying the effective lens position (ELP) equations for patients with Marfan Syndrome (MFS) and ectopia lentis (EL) undergoing in-the-bag IOL implantation.

Setting: Eye and ENT Hospital of Fudan University.

Design: Retrospective cohort study.

Methods: The formula-specific ELP was obtained from the SRK/T, T2, Holladay I, and HofferQ formulas. The back-calculated ELP was obtained based on the vergence formula using preoperative biometry, postoperative refraction, and the IOL power. The Generalized Linear Models or Gradient Boosting Machines were used to predict ELP or ELP error.

Results: A total of 255 patients (255 eyes) were assigned randomly into a training set and a validation set (7:3 ratio). Linear correlation identified axial length(AL), corneal height, and white-to-white as predictors for ELP and ELP error for patients with shorter AL (AL ≤ 24 mm). For those with longer AL (AL > 24 mm), AL and the central corneal radius were identified as the primary predictors. Incorporating these predictors into the modified ELP formula significantly improved the accuracy in the validation set, including SRK/T, T2, Haigis, Holladay I, and HofferQ formulas. The improvement was more pronounced in patients with shorter AL. Additionally, the GLM-modified formulas outperformed both the Barrett Universal II and Kane formulas. The accuracy across different ocular dimensions was comparable among the modified formulas, based on which an online calculator was developed.

Conclusions: Using the more accurately predicted ELP can significantly improve the accuracy of existing formulas in patients with MFS.

The rising age of pilots and the extension of retirement age underscore the importance of investigating Presbyopia correction intraocular lenses during cataract surgery for Aviation Pilots. This study aims to assess recommendations from aviation regulatory agencies, providing guidance on the use of multifocal intraocular lenses in both commercial and military pilots. A review analysed the perspectives of aviation regulatory agencies regarding the implantation of multifocal intraocular lenses in pilots. Findings reveal a lack of consensus among agencies regarding the use of multifocal intraocular lenses. Some adopt a permissive stance, permitting their use, while others maintain restrictive approaches. Variations in the post-cataract surgery unfit assessment period were observed, ranging from six to twelve weeks. The implantation of multifocal intraocular lenses in aviation pilots remains contentious. Further research is crucial to address unresolved aspects associated with using multifocal intraocular lenses in this context.

Abstract: Harold Ridley permanently implanted the first intraocular lens (IOL) in 1950. The widely accepted narrative is that Ridley and his invention received a hostile reception from Stewart Duke-Elder and other ophthalmic thought leaders. Ridley suffered greatly but was eventually vindicated as later IOL designs were widely accepted. This narrative casts Ridley as a prophetic innovator who suffered and eventually triumphed against the forces of animosity, jealousy and close-mindedness arrayed against him. We argue that this narrative is biased because it was told by Ridley himself and amplified by his biographer and close friend, David Apple. There were good reasons to be skeptical of Ridley's invention. Ridley had not done pre-clinical studies, so his first patients suffered avoidable complications. He worked in secret at a time when openness was the norm. Ridley's IOL had a high percentage of poor outcomes. The cautious approach that Duke-Elder and others had towards IOLs is understandable. The accurate history is a story of a clash of worldviews between an inventor who was focused on innovating quickly to solve a major clinical problem and established leaders who were concerned about the harm to patients from a flawed invention. The skepticism of established thought leaders remains a valuable check on aggressive innovation today.

One of the most impactful recent developments in the glaucoma community has been the concept of interventional glaucoma. In brief, this paradigm shift involves proactive rather than reactive intervention to address glaucoma earlier in the disease process, including in both standalone and combination-cataract settings. By intervening earlier with minimally invasive surgical, laser, or drug-delivery treatments instead of prolonged topical medications, interventional glaucoma aims to take the burden of medication compliance off the patient. It also allows for standalone surgical interventions rather than letting cataract surgery dictate the glaucoma treatment plan. This interventional mindset has been made possible by the increasing diversity and availability of effective minimally invasive treatment options. With these options as a springboard, it is time to reevaluate and advance the traditional glaucoma treatment paradigm.

Purpose: To evaluate the rotational stability and visual performance of the enVista toric intraocular lens (IOL) (MX60ET) in cataract patients with preexisting astigmatism.

Setting: 6 U.S. sites.

Design: Prospective, multicenter.

Methods: Cataract patients 18 years and older with preexisting astigmatism (0.77 to 4.53 diopters [D]) underwent phacoemulsification and implantation of enVista toric IOL (MX60ET). Outcome measures were the proportion of patients with absolute IOL axis rotation of ≤5 degrees, uncorrected and corrected distance visual acuities (UDVA and CDVA) at 4 m, uncorrected intermediate visual acuity (UIVA) at 66 cm, manifest refraction, and adverse events. The patients were followed up on days 1 to 2, 7 to 14, 30 to 60, and 120 to 180.

Results: Mean astigmatism of 101 eyes (101 patients) reduced from 1.47 ± 0.64 D preoperatively to 0.38 ± 0.38 D at days 120 to 180 ( P < .001), with 88.1% (N = 89/101) of eyes achieving astigmatism within 0.75 D. Mean postoperative UDVA and UIVA were 0.10 ± 0.16 and 0.25 ± 0.15 logMAR, respectively. While 79.2% (N = 80/101) of patients had postoperative UDVA of 20/32 or better, 63.9% (N = 62/97) had UIVA of 20/40 or better. The mean toric IOL rotation from the operative visit to days 30 to 60 was 1.97 ± 2.06 degrees, with 97.4% (N = 74/76) of eyes showing toric IOL rotation of 5 degrees or less.

Conclusions: The enhanced enVista toric IOL (MX60ET) demonstrated excellent rotational stability and astigmatic outcomes indicating good efficacy of the IOL for the correction of astigmatism during cataract surgery.

Purpose: To evaluate and compare dynamic vault range (DVR) and asymmetry of the vault during a 3-month follow-up after the implantation of 2 posterior chamber phakic intraocular lenses (pIOLs).

Setting: Aver Clinic, Madrid, Spain.

Design: Prospective comparative study.

Methods: 119 eyes (65 patients) that underwent refractive surgical correction with implantation of 1 of 2 distinct pIOLs were enrolled: Eyecryl Phakic from Biotech Vision Care (Eyecryl group, 72 eyes) and Evo Visian Implantable Contact Lens from Staar Surgical (ICL group, 47 eyes). Besides evaluation of visual acuity, refraction, and ocular integrity, the pIOL vault centrally and at 2 mm nasally and temporally as well as the DVR from photopic (50 lux) to mesopic (10 lux) illumination conditions were measured.

Results: No significant differences were found between the pIOL groups in visual and refractive outcomes ( P ≥ .454). No significant differences between the groups were found in central (523.72 ± 168.4 vs 494.16 ± 156.7 μm, P = .248) and temporal (499.43 ± 155.8 vs 431.28 ± 150.5 μm, P = .067) vaults. However, nasal vault was significantly lower in the ICL group (465.6 ± 149.1 vs 375.4 ± 144.0 μm, P = .045). A trend of a larger DVR was observed in the ICL group, although differences between groups did not reach statistical significance (54.00 ± 36.39 vs 86.5 ± 57.9 μm, P = .070). The pIOL diameter only correlated significantly with vault measurements in the ICL group ( r ≥ 0.650, P < .001).

Conclusions: The Eyecryl pIOL showed more symmetric vaults and a trend of fewer light-induced changes in the central vault compared with the ICL pIOL. The clinical relevance of this finding should be investigated further.

Purpose: To report functional and refractive outcomes of manual arcuate keratotomy (AK) with compression sutures for high regular postkeratoplasty astigmatism.

Setting: Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.

Design: Retrospective analysis.

Methods: This study included 90 eyes with high regular postkeratoplasty astigmatism (>4 diopters [D]) who received AK with compression sutures between 2010 and 2022. Functional and refractive outcomes were assessed by evaluating topographic indices and by performing vector astigmatism and Fourier analysis.

Results: At last follow-up (mean 13.7 ± 16.6 months), corrected distance visual acuity improved from 0.59 ± 0.28 to 0.34 ± 0.25 logMAR. Cylinder magnitude decreased from 9.91 ± 2.88 to 5.42 ± 3.35 D. Surface asymmetry index, irregular astigmatism index, and corneal eccentricity index were equal to preoperative values, whereas surface regularity index approached normal values at last follow-up. Fourier analysis indicated a decrease in the regular astigmatic component, whereas nonregular components (asymmetry and higher-order irregularity) remained stable. In vector astigmatism analysis, target-induced astigmatism magnitude was 9.92 ± 2.86 D and surgically induced astigmatism magnitude was 10.16 ± 4.86 D (correction index of 0.91 ± 0.48) with a difference vector of 5.42 ± 3.35 D at last follow-up. Correction of astigmatism magnitude was adequate in 40% of the eyes, undercorrected in 30%, and overcorrected in 30%. Angle of error was <|22.5 degrees| in 88% resulting in a low risk of off-axis treatment.

Conclusions: AK with compression sutures is a simple, relatively effective, and safe surgical procedure for astigmatism reduction after keratoplasty. In case of regular astigmatism, the procedure does not increase corneal irregularities. The remaining refractive error might be further corrected by spectacles, contact lenses, or toric intraocular lens implantation (in-the-bag/add-on), thus reducing the need for repeat keratoplasty.